TREATMENT OF PIPKIN FRACTURES

Because of the controversy that exists about therapy for the Pipkin fr acture, the treatment and results of 117 fractures of the femoral head were reviewed and re-evaluated at least 1 year after the trauma had t aken place. The cases were taken from eight publications in the litera ture from 1983 to 1995. The lesions in this collection comprised 35% ( n = 41) type 1, 40% (n = 47) type II, 10% (n = 12) type III and 15% (n = 17) type IV fractures classified after the Pipkin system. Seventy-f our percent of patients (n = 87) were operated on; only type I lesions were treated conservatively in 42%, thus more often than average. The re were 57 complications with equally frequent head necroses (14.5%) a nd severe coxarthroses. Coxarthrosis was doubled after conservative tr eatment versus operation (23% vs. 13%). There was no difference in res pect to head necrosis. Postoperatively, 18 (14%) periarticular ossific ations were registered. Forty-one (75%) of 55 Pipkin I and II fracture s had an at least ''good'' outcome; the portion of conservative treatm ent was highter than operative treatment (88% vs 69%). Still these res ults have to be seen with respect to the use of treating simple lesion s primarily conservatively with the minimum of 6 weeks of traction the rapy, thus counting the latter patients in this group. According to th e literature, we think that if there are no vital contraindications, a ll Pipkin fractures should be treated operatively (early emergency ope ration) by reattaching bigger fragments and extracting smaller fragmen ts in Pipkin I and Il fractures, trying to save the heads in young, ac tive patients with Pipkin ill fractures in contrast to primary endopro theses in elderly patients with coxarthrosis with Pipkin IV fractures (unstable and displaced fractures of the acetabulum).